Provider Demographics
NPI:1043597099
Name:DEPRIEST, CANDIE (MHPP)
Entity Type:Individual
Prefix:
First Name:CANDIE
Middle Name:
Last Name:DEPRIEST
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N EDMONDS AVE
Mailing Address - Street 2:
Mailing Address - City:MC CRORY
Mailing Address - State:AR
Mailing Address - Zip Code:72101-8000
Mailing Address - Country:US
Mailing Address - Phone:870-731-0345
Mailing Address - Fax:870-731-0345
Practice Address - Street 1:202 N EDMONDS AVE
Practice Address - Street 2:
Practice Address - City:MC CRORY
Practice Address - State:AR
Practice Address - Zip Code:72101-8000
Practice Address - Country:US
Practice Address - Phone:870-731-0345
Practice Address - Fax:870-730-0345
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator